Service de gastroentérologie et d'hépatologie, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France.
Gastrointest Endosc. 2010 Apr;71(4):760-7. doi: 10.1016/j.gie.2009.11.004. Epub 2010 Feb 18.
Patients with hereditary hemorrhagic telangiectasia (HHT) often present with recurrent anemia because of epistaxis or GI bleeding in relation to telangiectases mostly located in the stomach or small bowel. Capsule endoscopy is considered a major diagnostic tool for small-bowel diseases, but the impact of capsule endoscopy imaging on patient management in HHT is poorly understood.
To clarify the contribution of capsule endoscopy in selected patients with HHT.
Prospective, descriptive study.
Multicenter, two university hospital tertiary-care centers, from January 2003 to June 2007.
This study involved 30 patients with HHT and severe anemia (hemoglobin <9 g/dL; normal: 11-15 g/dL) and minimal epistaxis or moderate anemia but overt GI bleeding.
Capsule endoscopy investigation.
Clinical characteristics and capsule endoscopy results and their clinical consequences.
Capsule endoscopy detected gastric and small-bowel telangiectases in 14 (46.7%) and 26 (86.7%) cases, respectively. Active bleeding was present in 36.7% of cases. Diffuse telangiectases were detected in 42.3% without correlation with age, sex, or type of HHT mutation. Further investigations were carried out as a consequence of the capsule endoscopy results in 67% of cases. Treatment, consisting mostly of endoscopic argon plasma coagulation, was scheduled in 46.7% of patients.
Our population was essentially composed of patients with the ALK1 mutation.
This study shows that there is a high diagnostic yield for capsule endoscopy in selected patients with HHT. Capsule endoscopy makes possible precise mapping of lesions and has a considerable impact on the management of these selected patients by using a predefined algorithm: a limited number of accessible lesions is suitable for endoscopic treatment, whereas innumerable diffuse lesions require a medical approach. We suggest that capsule endoscopy could be a first-line, noninvasive, digestive tract examination in selected patients with HHT.
遗传性出血性毛细血管扩张症（HHT）患者常因位于胃或小肠的毛细血管扩张症而反复出现鼻出血或胃肠道出血，导致贫血。胶囊内镜被认为是小肠疾病的主要诊断工具，但胶囊内镜成像对 HHT 患者管理的影响知之甚少。
阐明胶囊内镜在 HHT 患者中的作用。
前瞻性描述性研究。
多中心，两所大学医院的三级保健中心，2003 年 1 月至 2007 年 6 月。
本研究纳入了 30 例 HHT 患者，这些患者有严重贫血（血红蛋白<9g/dL；正常值为 11-15g/dL）和轻度鼻出血或中度贫血但有明显胃肠道出血。
胶囊内镜检查。
临床特征、胶囊内镜结果及其临床后果。
胶囊内镜分别在 14 例（46.7%）和 26 例（86.7%）患者中检测到胃和小肠毛细血管扩张症，分别有 36.7%的患者有活动性出血。42.3%的患者弥漫性毛细血管扩张，与年龄、性别或 HHT 突变类型无关。根据胶囊内镜结果，67%的患者进行了进一步检查。大多数患者接受了内镜氩气等离子凝固治疗，占 46.7%。
我们的研究人群主要由 ALK1 基因突变的患者组成。
本研究表明，在选定的 HHT 患者中，胶囊内镜具有较高的诊断率。胶囊内镜能够精确地对病变进行定位，并通过使用预设的算法对这些选定的患者进行治疗，对患者的管理产生重大影响：可治疗数量有限的可接近病变，而大量弥漫性病变需要采用药物治疗。我们建议，在选定的 HHT 患者中，胶囊内镜可以作为一种一线、非侵入性的消化道检查方法。
